A&A practice
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Patients with cold agglutinin disease who undergo total hip arthroplasty (THA) are rarely encountered. Patients with cold agglutinin disease are very sensitive to cold ambient temperatures and require scrupulous perioperative body-temperature management. ⋯ Thus, perioperative management of patients with cold agglutinin disease undergoing THA requires more than just scrupulous systemic temperature management. Here, we present the successful perioperative management of a patient with severe cold agglutinin disease who underwent THA with a cemented stem.
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Case Reports
Acute Intraoperative Hyperkalemia During Robot-Assisted Radical Cystectomy: A Case Report.
A 50-year-old man with muscle-invasive bladder cancer was scheduled for a robotic radical cystectomy. Four hours into the surgery, his electrocardiogram showed rhythm disturbances. Arterial blood gas analysis showed a serum potassium concentration of 6.6 mEq/L. ⋯ The procedure was completed after conversion to an open surgery. The postoperative serum potassium concentration was reduced to 4.6 mEq/L, and the patient was extubated. The remainder of his hospital stay was uneventful.
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Thoracic epidurals remain the optimal method for providing postoperative analgesia after complex open abdominal and thoracic surgeries. However, they can be challenging to both place and maintain, as evidenced by a failure rate that exceeds 30%.1 Proper identification of the epidural space and accurate placement of the catheter are critical in order to deliver effective postoperative analgesia and avoid failure.2,3 This case series investigated the difficulty in correctly identifying the proper vertebral level for thoracic epidural catheter procedures when performed in the lateral decubitus position.
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Case Reports
A Case Report of an Incidental Ultrasound Finding in a Suspected Malignant Hyperthermia Patient.
Malignant hyperthermia (MH) is a rare but life-threatening genetic disorder of the skeletal muscles triggered by inhalation anesthetics or succinylcholine. A 49-year-old female developed symptoms of MH shortly after a lumbar surgery. ⋯ On receiving dantrolene, her symptoms improved within 20 minutes; a subsequent ultrasound revealed no fasciculations. Although halothane contracture testing was not available, the fasciculations that resolved with dantrolene administration in a MH suspected patient opens up a new potential avenue of diagnostics.
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Complex regional pain syndrome (CRPS) poses a diagnostic and management challenge for many clinicians, particularly when disease symptomatology waxes and wanes. Monitoring symptom variations with digital and infrared thermal images allows for more accurate evaluation of disease progression overtime. ⋯ The images were instrumental toward establishing the initial diagnosis of CRPS, monitoring disease progression, and assessing response to treatment. We discuss the present understanding of infrared thermography in CRPS and advocate for its routine use at the beside.